NHS England » Mental health personal health budgets: redesigning the recovery pathway

This case study is an example of the collaborative work taking place to deliver physical health support services for people living with severe mental illness. It is one of a collection of case studies that support our guidance for integrated care systems on Improving the physical health of people living with severe mental illness, published in January 2024.

Organisations: North East London ICS, The Advocacy Project and East London NHS Foundation Trust.

Aim and rationale

People in the borough were ‘getting stuck’ in their mental health recovery pathway and remaining in secondary services longer than necessary. This was in part due to local services not fully meeting people’s recovery goals. The aim was to use personal health budgets (PHBs) in a redesigned recovery pathway to help overcome barriers to achieving recovery goals, including for people’s physical health.

Development and implementation

The work started with a one-year pilot of a recovery pathway co-produced with people with lived experience.
A shared recovery plan called ‘Me and My Goals’ was developed. In this, people consider their mental health, physical health and social needs, and identify three goals to stay well and the next steps for each.
The plan can be shared on the Patients Know Best platform (a platform that allows patients to access all their patient data and share this with relevant services) alongside information on their annual SMI physical health check.
As part of the pathway, a person can be referred to The Advocacy Project to apply for a PHB. Clear information co-produced with people with lived experience is provided, including case examples, to help people think about how a PHB could support their recovery.
Examples of how PHBs have been used to help achieve recovery goals in relation to physical health are:
- an air fryer for healthier cooking
- monthly boxing membership to improve physical health and to manage medication side effects
- a table tennis bat to make it possible to join a table tennis club and build confidence
- a gardening course to build gardening skills, leading to volunteering or employment and the opportunity to meet new people.
These budgets were monitored during the pilot year using ReQoL-10 as the Patient Reported Outcome Measure at the point of referral, 6-week review and closure.

Overcoming challenges

The previous system for accessing PHBs was burdensome and lengthy, creating a further barrier for people. To overcome this, in discussion with a wide range of stakeholders the maximum value for direct payment budgets was agreed; amounts under £250 can now be signed off directly by professionals supporting the person with their recovery goals. People should now be able to receive a PHB of under £250 in 2–3 days. They sign a co-produced direct payment agreement which outlines how the PHB must be used.

Outcomes

The success of the pilot has led to recurrent funding being identified and the PHB offer has been widened, particularly in response to needs identified during the Covid pandemic.
Since April 2020, over 1,000 PHBs have gone live, with 313 people in 2022/23 requesting a PHB to achieve their recovery goal.
Many of those using PHBs through the pathway are from Black, Asian and minority ethnic groups (in 2022/23 42% of PHB holders were Black, while Black people make up 22% of the borough’s population).

Recommendations

Co-production is essential to the development of a recovery pathway that works for people by understanding the barriers they encounter.
It is important to provide a holistic approach to recovery and to support patients to consider all factors that can impact on their recovery journey.
Even very small PHBs can have a big impact by removing the barrier of income inequality when a person is seeking to achieve recovery goals.

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